重症脑血管病患者术后呼吸系统顺应性与颅内压的相关性研究

Correlation between postoperative respiratory system compliance and intracranial pressure in patients with severe cerebrovascular disease

目的研究呼吸系统顺应性与不同水平呼气末正压(PEEP)对重症脑血管病患者术后颅内压、脑灌注压及中心静脉压的影响。方法回顾性分析重症脑血管病行手术治疗且需机械通气患者30例,根据呼吸系统顺应性情况将患者分为正常呼吸系统顺应性组[呼吸系统顺应性(Crs)≥45 ml/cmH_(2)O,A组)和低呼吸系统顺应性组(Crs<45 ml/cmH_(2)O,B组),记录不同水平PEEP下的颅内压、平均动脉压及中心静脉压,计算脑灌注压。比较2组不同水平PEEP对颅内压、平均动脉压、脑灌注压及中心静脉压的影响。结果在A组患者中,随着PEEP从0~12 cmH_(2)O增加,平均动脉压从(97±5)mmHg降至(87±5)mmHg(P<0.05),脑灌注压从(83±5)mmHg降至(73±5)mmHg(P<0.05);中心静脉压从(7.4±0.3)cmH_(2)O升至(10.1±0.7)cmH_(2)O(P<0.05)均有显著改变;B组患者随着PEEP增加平均动脉压、脑灌注压及中心静脉压变化不明显。在PEEP增加后,2组的颅内压均未有明显改变(P>0.05)。结论对于呼吸系统顺应性正常的重症脑血管病行手术治疗且需机械通气的患者,使用不同水平PEEP对颅内压无明显影响,但会降低脑灌注压和平均动脉压,升高中心静脉压;而对于呼吸系统顺应性降低的行手术治疗且需机械通气的重症脑血管病患者,使用PEEP对颅内压、脑灌注压、平均动脉压及中心静脉压均无明显影响。

Objective To investigate the effects of respiratory system compliance(Crs)and different positive end-expiratory pressure(PEEP)levels on postoperative intracranial pressure(ICP),cerebral perfusion pressure(CPP)and central venous pressure(CVP)in patients with severe cerebrovascular disease.Methods The clinical data of 30 patients with severe cerebrovascular disease received surgical treatment and required mechanical ventilation were retrospectively analyzed.According to Crs,all patients were divided into normal Crs group(Crs≥45 ml/cmH_(2)O,group A)and low Crs group(Crs<45 ml/cmH_(2)O,group B).The ICP,mean arterial pressure and CVP were recorded under different PEEP levels,and the cerebral perfusion pressure was calculated.The effects of different PEEP levels on ICP,mean arterial pressure,CPP and CVP were compared between the two groups.Results In group A,PEEP level increased from 0 to 12 cmH_(2)O,mean arterial pressure reduced from(97±5)mmHg to(87±5)mmHg(P<0.05),CPP reduced from(83±5)mmHgto(73±5)mmHg(P<0.05),and CVP elevated from(7.4±0.3)mmHg to(10.1±0.7)cmH_(2)O(P<0.05),with significant changes.In group B,the mean arterial pressure,CPP and CVP did not change significantly along with the increase of PEEP level.After the increase of PEEP,there was no significant change in ICP in both groups(P>0.05).Conclusion For patients with severe cerebrovascular disease with normal Crs received surgical treatment and required mechanical ventilation,using different PEEP levels may not significantly affect ICP,but may reduce CPP and mean arterial pressure and elevate CVP,while PEEP exhibits no significant effect on ICP,CPP andCVP for patients with decreased Crs.